Southwest Virginia

knowing when NOT to do something

Medical costs are out of control. Yet, outcomes are not improving. Why?


Greater minds than mine have grappled with that question, and it serves as the foundation for our ongoing debate about whether, why and how to reform healthcare. Do we limit the tests and procedures that doctors are allowed to order or perform? Do we limit what services or medications patients are allowed to receive? Or do we do something much smarter, and help to guide patients, their families and physicians in having a conversation about how useful certain tests or procedures might be?

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when doctors can't hear

We have discussed child abuse on this blog before, and I promised you more in a series I began last year. This time I want to tell you a story from when I was a medical student--admittedly some of you will consider this ancient history, and perhaps you should. I do not remember the names of my preceptors or the name of the patient. So there is little chance I will tell you anything I shouldn't. In fact, I don't even remember the name of the hospital where this rotation occurred. Yet I remember the patient, her husband, her daughter as if it were yesterday. 

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moving is hard

If you are a frequent, or even an intermittent reader of this blog, you have probably noticed a few things:

  • The blog was unavailable for a few days at the end of January
  • The comment section was not active into early February
  • The blog looks different than it used to

Although a blog redesign was in the works for a future date, we were faced with an immediate need to revise and revamp for the following reasons, which may actually be too much information for some of you. Feel free to skip the explanation and just know that I haven't chosen to stop blogging, or interfere with you, the reader from accessing what might be important to you.

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if I had won Powerball

Did you see the happy winners in the papers or on the internet? A “once in a lifetime” moment.

For most, winning the lottery is not the godsend they have dreamt of.

To suddenly become part of the one per cent is not easy.  Most fritter away their winnings, and end up much less happy than they were before.  So I have thought about this a lot. What would I do if I won a huge amount of money? Of course, its not at all clear to me WHY I daydream about such an event, as I am by nature not a gambling kind of gal. And, they tell me, you can’t win if you don’t play.

So its not likely to happen.

On the other  hand, somehow, maybe some day it WILL happen. So I should be prepared. Don't you agree?

Here is how I would spend my money.

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on the art of reflecting

I must say I am a bit disappointed. I anticipated that my last post would have generated millions of comments, or at least a couple. I was anticipating posting your thoughts and insights into the process of reflection. Oh well, such is the plight of the blogger. They say fewer than 1 per cent of readers ever leave a comment. I guess “they” are correct. So, in case you missed it, I asked you to look at five photos of sunsets. They were basically of the same scene from my vacation, but taken under varying conditions.

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reflections on reflection

As I have written recently, I am working with the pediatric residents on enhancing professionalism in our practice of pediatrics. Part of this entails the process of reflecting upon situations or cases that exemplify issues which either pose a challenge to one of the pillars of professionalism, or have presented personal challenges in response to difficult situations.

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do you need a vacation?

Of course you do. Everyone does, at least occasionally.

I know that I certainly need one, and am delighted that I am about to start my one week “family” vacation.

A time to enjoy the grandkids, who live too far away for me to visit as much as I would like.

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what's the big deal about budget season?

Those of you who know me in person may have detected a bit of increased tension over the last few weeks. I find I am not as fun to be around as usual. I am probably scowling more than I am smiling. I have frequent headaches.

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a first step toward humanism

I have become rather obsessed lately with how to facilitate the development of professionalism in physicians.

Humanism is important in medical practice, and is included as a component in most definitions of medical professionalism. A healthcare practitioner who acts humanely thinks about the person under his or her care in a holistic manner, and behaves accordingly. Such a practitioner considers multiple perspectives and includes the patient and family in the decision-making process, identifies where the patient's perspectives might conflict with his own, or with societal norms and values, and finally acts in a way that puts the patient's perspectives and values first.

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the worst case

This is the first "story" in my intermittent ongoing series on child abuse, sometimes called "child maltreatment"  or "non-accidental trauma." I have found this one very difficult to write.

I have been working on it for over two weeks, although it has been begging to be written for over two decades.

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